Helping Veterans Navigate Dual Pharmacy Benefits

背景：近30%的糖尿病退伍军人双重使用联邦医疗保险D部分和VA部分填充 他们的抗糖尿病药物，以及双重使用者的血糖控制更差， 服药依从性比只通过退伍军人填充的退伍军人更高。然而，几乎没有什么资源可以提供帮助 退伍军人理解并在这些双重药房福利之间导航。 意义/影响：这项研究的目标是了解退伍军人是如何选择 在VA和D部分之间，找出知识差距，并严格制定和测试 将教育和优化退伍军人对处方覆盖面的选择的干预措施。 创新：这项研究具有创新性，因为它：i)使用陈述偏好研究 一种称为离散选择实验的方法，用于量化退伍军人在选择时的偏好 哪些药房从中受益，以满足他们的抗糖尿病药物和ii)严格 开发首个面向退伍军人的决策辅助工具，帮助提高退伍军人的决策能力 在哪里给他们的药物配药。通过实施以退伍军人为中心的干预措施，重点关注 对于患有昂贵和普遍疾病的老龄化人口来说，护理和医疗保健的价值， 建议书总体上与HSR&D、PBM和VA的战略目标保持一致。 具体目标：CDA-2提案的具体目标是：1)确定药物获取 D部分注册退伍军人在填写抗糖尿病药物时面临的挑战和信息需求 通过退伍军人管理局或联邦医疗保险D部分进行药物治疗；2)评估退伍军人的偏好 如处方覆盖范围、旅行时间、等待时间、用药费用和 不良事件影响D部分登记的退伍军人选择服用抗糖尿病药物的位置； 3)制定和评估帮助D部分入学的决策援助的可行性和可接受性 退伍军人了解VA和Medicare Part D处方药福利以优化选择 在哪里填充药物；以及4)评估VA和D部分的双重使用如何填充抗糖尿病药物 药物影响退伍军人、医疗保险和退伍军人管理局的药物支出。 方法：建议的研究由四个项目组成，全部集中在D部分--已录取 使用抗糖尿病药物的退伍军人。项目1是一项定性研究，以确定知识 退伍军人在补药时遇到的差距和其他药物获取障碍 通过D部分与VA部分进行药物治疗。项目1将包括对D部分的24次访谈- 招募患有2型糖尿病的退伍军人，并与照顾者进行了12次访谈。项目2包括 一项离散选择实验研究，估计退伍军人如何在不同的 如处方覆盖范围、旅行时间、等待时间、用药费用和 当他们决定在哪里配药时，会出现不良事件。项目3将涉及 根据调查结果开发和评估决策辅助工具的可行性和可接受性 来自目标1和目标2。项目4将包含使用VA公司的回溯性队列研究 数据仓库将医疗记录链接到医疗保险索赔数据，以研究双重影响 使用药房福利来支付退伍军人、医疗保险和退伍军人管理局的费用。 执行/下一步：将提交两个IIR，以支持：i)扩大二级市场 为今后执行决策辅助提供信息的数据分析和二)混合类型I 有效性-实施试验，评估决策援助对退伍军人的影响 满意度；药物供应、转换和依从性；血糖控制；以及 退伍军人和退伍军人。

Background: Nearly 30% of Veterans with diabetes dually use Medicare Part D and VA to fill their antidiabetic medications, and dual users have poorer glycemic control and poorer medication adherence than Veterans who fill only through VA. Yet few resources exist to help Veterans understand and navigate between these dual pharmacy benefits. Significance/Impact: The goal of this research is to understand how Veterans are choosing between VA and Part D, identify knowledge gaps, and rigorously develop and test an intervention that will educate and optimize Veteran choice on prescription coverage. Innovation: This research is innovative because it: i) uses a stated-preference research method, called a discrete choice experiment, to quantify Veteran preferences when choosing which pharmacy benefit through which to fill their antidiabetic medications and ii) rigorously develops the first Veteran-facing decision aid that helps improve Veteran decision-making about where to fill their medication. By applying a Veteran-centered intervention focused on access to care and health care value to an aging population with a costly and prevalent condition, this proposal aligns with strategic goals for HSR&D, PBM, and VA in general. Specific Aims: The specific aims of the CDA-2 proposal are: 1) Identify medication acquisition challenges and informational needs that Part D-enrolled Veterans have when filling antidiabetic medications through VA or Medicare Part D; 2) Estimate how Veteran preferences around aspects such as prescription coverage, travel time, wait time, medication copay, and chance of adverse events influence where Part D-enrolled Veterans choose to fill antidiabetic medications; 3) Develop and assess feasibility and acceptability of a decision aid that helps Part D-enrolled Veterans comprehend VA and Medicare Part D prescription benefits to optimize choice on where to fill medications; and 4) Evaluate how dual use of VA and Part D to fill antidiabetic medications affects medication expenditures for Veterans, Medicare, and VA. Methodology: The proposed research consists of four projects, all focused on Part D-enrolled Veterans using antidiabetic medications. Project 1 is a qualitative study to identify knowledge gaps and other medication acquisition barriers that Veterans experience when filling medications through Part D versus VA. Project 1 will comprise of 24 interviews with Part D- enrolled Veterans with type 2 diabetes, and 12 interviews with caregivers. Project 2 consists of a discrete choice experiment study that estimates how Veterans trade off between different aspects such as prescription coverage, travel time, wait time, medication copay, and chance of adverse events when they decide where to fill their medications. Project 3 will involve the development and assessment of feasibility and acceptability of a decision aid based on findings from Aims 1 and 2. Project 4 will encompass a retrospective cohort study, using VA Corporate Data Warehouse medical records linked to Medicare claims data, to study the impact of dual use of pharmacy benefit on costs to Veterans, Medicare, and VA. Implementation/Next Steps: Two IIRs will be submitted to support: i) an expanded secondary data analysis that informs future implementation of the decision aid and ii) a hybrid type I effectiveness-implementation trial assessing the impact of the decision aid on Veteran satisfaction; medication supply, switching, and adherence; glycemic control; and costs to the Veteran and VA.